Up-to-7标准和米兰标准对多发性肝细胞癌患者肝切除术后的预后预测价值分析  

Predictive value analysis of up-to-7 criteria and Milan criteria on the prognosis of patients with multifocal hepatocellular carcinoma after liver resection

作　　者：张宇[1] 吴丽君[2] 马良[1] 吴飞翔[1] 向邦德[1] 黎乐群[1] ZHANG Yu;WU Lijun;MA Liang;WU Feixiang;XIANG Bangde;LI Lequn(Department of Hepatobiliary Surgery,Affiliated Tumor Hospital,Guangxi Medical University,Nanning 530021,China;Department of Hepatobiliary Surgery,the First Affiliated Hospital,Guangxi Medical University)

机构地区：[1]广西医科大学附属肿瘤医院肝胆外科,530021 [2]广西医科大学第一附属医院肝胆外科

出　　处：《天津医药》2022年第6期653-657,共5页Tianjin Medical Journal

基　　金：国家自然科学基金资助项目(81960534)。

摘　　要：目的比较up-to-7标准和米兰标准对多发性肝细胞癌(HCC)患者肝切除术后预后的预测能力。方法收集252例行肝切除术治疗的多发性HCC患者的临床病理资料。采用Kaplan-Meier法计算累积总生存率和无瘤生存率,Log-rank检验用于比较2个标准下符合组和超越组间生存率的差异。Cox多因素回归分析确定影响总生存率和无瘤生存率的独立危险因素。t-ROC曲线分析和ROC曲线下面积(AUC)用于评估预测总生存率和无瘤生存率的准确性。结果米兰标准符合组(36例)和超越组(216例)患者累积总生存率和无瘤生存率的差异均无统计学意义(均P>0.05);而up-to-7标准符合组(92例)患者的累积总生存率和无瘤生存率均明显高于up-to-7标准超越组(160例)患者(均P<0.05)。多因素Cox回归分析结果显示,年龄≥60岁(HR=1.649,95%CI:1.079~2.520)、AFP≥400μg/L(HR=1.521,95%CI:1.046~2.212)和超越up-to-7标准(HR=1.510,95%CI:1.013~2.249)是影响多发性HCC患者术后累积总生存率的独立危险因素(均P<0.05);较高水平AST(HR=1.004,95%CI:1.001~1.007)和超越up-to-7标准(HR=2.102,95%CI:1.499~2.948)是影响多发性HCC患者术后累积无瘤生存率的独立危险因素(均P<0.05)。t-ROC曲线分析显示,up-to-7标准预测累积总生存率和累积无瘤生存率的AUC值均大于米兰标准。结论Up-to-7标准在预测多发性HCC患者肝切除术后的预后方面优于米兰标准。Objective To compare the predictive ability of up-to-7 criteria and Milan criteria in the prognosis ofpatients with multifocal hepatocellular carcinoma(HCC)after liver resection.Methods The clinicopathological data of 252 patients with multifocal HCC treated with hepatectomy were collected.Overall survival(OS)and disease-free survival(DFS)were estimated by Kaplan-Meier method,and Log-rank test was used to compare the differences in survival between themeeting group and the exceeding group under the two criteria.Multivariate Cox regression analysis was used to determineindependent risk factors affecting OS and DFS.The accuracy in predicting OS and DFS was evaluated using t-ROC curveanalysis and the area under ROC curve(AUC).Results There were no significant differences in OS and DFS between theMilan criteria meeting group(n=36)and the exceeding group(n=216).However,the OS and DFS were significantly higher inthe up-to-7 criteria meeting group(n=92)than those in the up-to-7 criteria exceeding group(n=160).Multivariate Coxanalyses determined that age≥60 years(HR=1.649,95%CI:1.079-2.520),AFP≥400μg/L(HR=1.521,95%CI:1.046-2.212)and exceeding up-to-7 criteria(HR=1.510,95%CI:1.013-2.249)were independent risk factors for OS in patientswith multifocal HCC after liver resection(all P<0.05).The higher AST level(HR=1.004,95%CI:1.001-1.007)andexceeding up-to-7 criteria(HR=2.102,95%CI:1.499-2.948)were independent risk factors for DFS in patients withmultifocal HCC after liver resection(P<0.05).ROC curve analyses showed that both the AUCs of up-to-7 criteria predicting OS and DFS were greater than those of Milan criteria.Conclusion The Up-to-7 criteria is superior to Milancriteria in predicting the prognosis of patients with multifocal HCC after liver resection.

关 键 词：肝细胞癌 肝切除术 预后 up-to-7标准 米兰标准 

分 类 号：R735.7[医药卫生—肿瘤]